|
HC LOCALIZATION DEVICE LEVEL 1
|
Facility
|
OP
|
$146.88
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna Commercial |
$124.85
|
| Rate for Payer: Aetna Medicare |
$38.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.90
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$120.75
|
| Rate for Payer: BCN Commercial |
$120.75
|
| Rate for Payer: BCN Medicare Advantage |
$36.72
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cofinity Commercial |
$126.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$132.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.16
|
| Rate for Payer: Mclaren Medicaid |
$25.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.56
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.85
|
| Rate for Payer: Nomi Health Commercial |
$120.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.16
|
| Rate for Payer: PACE Senior Care Partners |
$34.88
|
| Rate for Payer: PACE SWMI |
$36.72
|
| Rate for Payer: PHP Commercial |
$124.85
|
| Rate for Payer: PHP Medicare Advantage |
$36.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$127.79
|
| Rate for Payer: Priority Health Medicare |
$37.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.23
|
| Rate for Payer: Railroad Medicare Medicare |
$36.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.25
|
| Rate for Payer: UHC Core |
$122.64
|
| Rate for Payer: UHC Exchange |
$36.72
|
| Rate for Payer: UHC Medicaid |
$25.89
|
| Rate for Payer: UHC Medicare Advantage |
$36.72
|
| Rate for Payer: UHCCP Medicaid |
$25.89
|
| Rate for Payer: VA VA |
$36.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.16
|
|
|
HC LOC INFIL W/CS 15 MIN
|
Facility
|
IP
|
$147.26
|
|
| Hospital Charge Code |
37000007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$102.49 |
| Max. Negotiated Rate |
$132.53 |
| Rate for Payer: Aetna Commercial |
$125.17
|
| Rate for Payer: BCBS Trust/PPO |
$121.62
|
| Rate for Payer: BCN Commercial |
$121.62
|
| Rate for Payer: Cash Price |
$117.81
|
| Rate for Payer: Cofinity Commercial |
$126.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.81
|
| Rate for Payer: Healthscope Commercial |
$132.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.17
|
| Rate for Payer: Nomi Health Commercial |
$120.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.44
|
| Rate for Payer: PHP Commercial |
$125.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.59
|
| Rate for Payer: UHC Core |
$122.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.44
|
|
|
HC LOC INFIL W/CS 15 MIN
|
Facility
|
OP
|
$147.26
|
|
| Hospital Charge Code |
37000007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$132.53 |
| Rate for Payer: Aetna Commercial |
$125.17
|
| Rate for Payer: Aetna Medicare |
$38.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.02
|
| Rate for Payer: BCBS Complete |
$27.26
|
| Rate for Payer: BCBS MAPPO |
$36.81
|
| Rate for Payer: BCBS Trust/PPO |
$121.06
|
| Rate for Payer: BCN Commercial |
$121.06
|
| Rate for Payer: BCN Medicare Advantage |
$36.81
|
| Rate for Payer: Cash Price |
$117.81
|
| Rate for Payer: Cofinity Commercial |
$126.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.81
|
| Rate for Payer: Healthscope Commercial |
$132.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.44
|
| Rate for Payer: Mclaren Medicaid |
$25.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.66
|
| Rate for Payer: Meridian Medicaid |
$27.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.17
|
| Rate for Payer: Nomi Health Commercial |
$120.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.44
|
| Rate for Payer: PACE Senior Care Partners |
$34.97
|
| Rate for Payer: PACE SWMI |
$36.81
|
| Rate for Payer: PHP Commercial |
$125.17
|
| Rate for Payer: PHP Medicare Advantage |
$36.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.12
|
| Rate for Payer: Priority Health Medicare |
$37.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.49
|
| Rate for Payer: Railroad Medicare Medicare |
$36.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.59
|
| Rate for Payer: UHC Core |
$122.96
|
| Rate for Payer: UHC Exchange |
$36.81
|
| Rate for Payer: UHC Medicaid |
$25.96
|
| Rate for Payer: UHC Medicare Advantage |
$36.81
|
| Rate for Payer: UHCCP Medicaid |
$25.96
|
| Rate for Payer: VA VA |
$36.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.44
|
|
|
HC LOC INFIL W/CS 30 MIN
|
Facility
|
IP
|
$736.01
|
|
| Hospital Charge Code |
37000008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$512.26 |
| Max. Negotiated Rate |
$662.41 |
| Rate for Payer: Aetna Commercial |
$625.61
|
| Rate for Payer: BCBS Trust/PPO |
$607.87
|
| Rate for Payer: BCN Commercial |
$607.87
|
| Rate for Payer: Cash Price |
$588.81
|
| Rate for Payer: Cofinity Commercial |
$632.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.81
|
| Rate for Payer: Healthscope Commercial |
$662.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.61
|
| Rate for Payer: Nomi Health Commercial |
$603.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.01
|
| Rate for Payer: PHP Commercial |
$625.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$640.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$512.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.69
|
| Rate for Payer: UHC Core |
$614.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.01
|
|
|
HC LOC INFIL W/CS 30 MIN
|
Facility
|
OP
|
$736.01
|
|
| Hospital Charge Code |
37000008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$129.76 |
| Max. Negotiated Rate |
$662.41 |
| Rate for Payer: Aetna Commercial |
$625.61
|
| Rate for Payer: Aetna Medicare |
$191.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$230.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$230.00
|
| Rate for Payer: BCBS Complete |
$136.24
|
| Rate for Payer: BCBS MAPPO |
$184.00
|
| Rate for Payer: BCBS Trust/PPO |
$605.07
|
| Rate for Payer: BCN Commercial |
$605.07
|
| Rate for Payer: BCN Medicare Advantage |
$184.00
|
| Rate for Payer: Cash Price |
$588.81
|
| Rate for Payer: Cofinity Commercial |
$632.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.00
|
| Rate for Payer: Healthscope Commercial |
$662.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.01
|
| Rate for Payer: Mclaren Medicaid |
$129.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.20
|
| Rate for Payer: Meridian Medicaid |
$136.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$202.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.61
|
| Rate for Payer: Nomi Health Commercial |
$603.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.01
|
| Rate for Payer: PACE Senior Care Partners |
$174.80
|
| Rate for Payer: PACE SWMI |
$184.00
|
| Rate for Payer: PHP Commercial |
$625.61
|
| Rate for Payer: PHP Medicare Advantage |
$184.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$640.33
|
| Rate for Payer: Priority Health Medicare |
$185.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$512.26
|
| Rate for Payer: Railroad Medicare Medicare |
$184.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.69
|
| Rate for Payer: UHC Core |
$614.57
|
| Rate for Payer: UHC Exchange |
$184.00
|
| Rate for Payer: UHC Medicaid |
$129.76
|
| Rate for Payer: UHC Medicare Advantage |
$184.00
|
| Rate for Payer: UHCCP Medicaid |
$129.76
|
| Rate for Payer: VA VA |
$184.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.01
|
|
|
HC LOCM 100-199 MG/ML IODINE/ML1
|
Facility
|
IP
|
$3.83
|
|
|
Service Code
|
HCPCS Q9965
|
| Hospital Charge Code |
25500002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$3.16
|
| Rate for Payer: BCN Commercial |
$3.16
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Nomi Health Commercial |
$3.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC Core |
$3.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
|
|
HC LOCM 100-199 MG/ML IODINE/ML1
|
Facility
|
OP
|
$3.83
|
|
|
Service Code
|
HCPCS Q9965
|
| Hospital Charge Code |
25500002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.20
|
| Rate for Payer: BCBS Complete |
$0.71
|
| Rate for Payer: BCBS MAPPO |
$0.96
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$3.15
|
| Rate for Payer: BCN Medicare Advantage |
$0.96
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.96
|
| Rate for Payer: Healthscope Commercial |
$3.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: Mclaren Medicaid |
$0.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.01
|
| Rate for Payer: Meridian Medicaid |
$0.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Nomi Health Commercial |
$3.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: PACE Senior Care Partners |
$0.91
|
| Rate for Payer: PACE SWMI |
$0.96
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$0.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.33
|
| Rate for Payer: Priority Health Medicare |
$0.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.67
|
| Rate for Payer: Railroad Medicare Medicare |
$0.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC Core |
$3.20
|
| Rate for Payer: UHC Exchange |
$0.96
|
| Rate for Payer: UHC Medicaid |
$0.68
|
| Rate for Payer: UHC Medicare Advantage |
$0.96
|
| Rate for Payer: UHCCP Medicaid |
$0.68
|
| Rate for Payer: VA VA |
$0.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
|
|
HC LOOP AV 3/8 INCH OR 1/2 INCH
|
Facility
|
OP
|
$220.36
|
|
| Hospital Charge Code |
27000444
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.85 |
| Max. Negotiated Rate |
$198.32 |
| Rate for Payer: Aetna Commercial |
$187.31
|
| Rate for Payer: Aetna Medicare |
$57.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.86
|
| Rate for Payer: BCBS Complete |
$40.79
|
| Rate for Payer: BCBS MAPPO |
$55.09
|
| Rate for Payer: BCBS Trust/PPO |
$181.16
|
| Rate for Payer: BCN Commercial |
$181.16
|
| Rate for Payer: BCN Medicare Advantage |
$55.09
|
| Rate for Payer: Cash Price |
$176.29
|
| Rate for Payer: Cofinity Commercial |
$189.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.09
|
| Rate for Payer: Healthscope Commercial |
$198.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.27
|
| Rate for Payer: Mclaren Medicaid |
$38.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.84
|
| Rate for Payer: Meridian Medicaid |
$40.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.31
|
| Rate for Payer: Nomi Health Commercial |
$180.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.27
|
| Rate for Payer: PACE Senior Care Partners |
$52.34
|
| Rate for Payer: PACE SWMI |
$55.09
|
| Rate for Payer: PHP Commercial |
$187.31
|
| Rate for Payer: PHP Medicare Advantage |
$55.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$191.71
|
| Rate for Payer: Priority Health Medicare |
$55.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.37
|
| Rate for Payer: Railroad Medicare Medicare |
$55.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.92
|
| Rate for Payer: UHC Core |
$184.00
|
| Rate for Payer: UHC Exchange |
$55.09
|
| Rate for Payer: UHC Medicaid |
$38.85
|
| Rate for Payer: UHC Medicare Advantage |
$55.09
|
| Rate for Payer: UHCCP Medicaid |
$38.85
|
| Rate for Payer: VA VA |
$55.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.27
|
|
|
HC LOOP AV 3/8 INCH OR 1/2 INCH
|
Facility
|
IP
|
$220.36
|
|
| Hospital Charge Code |
27000444
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.37 |
| Max. Negotiated Rate |
$198.32 |
| Rate for Payer: Aetna Commercial |
$187.31
|
| Rate for Payer: BCBS Trust/PPO |
$182.00
|
| Rate for Payer: BCN Commercial |
$182.00
|
| Rate for Payer: Cash Price |
$176.29
|
| Rate for Payer: Cofinity Commercial |
$189.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.29
|
| Rate for Payer: Healthscope Commercial |
$198.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.31
|
| Rate for Payer: Nomi Health Commercial |
$180.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.27
|
| Rate for Payer: PHP Commercial |
$187.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$191.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.92
|
| Rate for Payer: UHC Core |
$184.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.27
|
|
|
HC LOWER EXT FASCIAL PLANE BLOCK UNILAT CONT
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 64474
|
| Hospital Charge Code |
37000030
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$261.00 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna Commercial |
$478.12
|
| Rate for Payer: BCBS Trust/PPO |
$309.71
|
| Rate for Payer: BCBS Trust/PPO |
$464.57
|
| Rate for Payer: BCN Commercial |
$309.71
|
| Rate for Payer: BCN Commercial |
$464.57
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cofinity Commercial |
$483.75
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Healthscope Commercial |
$506.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.12
|
| Rate for Payer: Nomi Health Commercial |
$307.50
|
| Rate for Payer: Nomi Health Commercial |
$461.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.88
|
| Rate for Payer: PHP Commercial |
$478.12
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$489.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$326.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$391.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$495.00
|
| Rate for Payer: UHC Core |
$313.12
|
| Rate for Payer: UHC Core |
$469.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.88
|
|
|
HC LOWER EXT FASCIAL PLANE BLOCK UNILAT CONT
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 64474
|
| Hospital Charge Code |
37000030
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$66.11 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna Commercial |
$478.12
|
| Rate for Payer: Aetna Medicare |
$146.25
|
| Rate for Payer: Aetna Medicare |
$97.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.78
|
| Rate for Payer: BCBS Complete |
$69.41
|
| Rate for Payer: BCBS Complete |
$104.12
|
| Rate for Payer: BCBS MAPPO |
$93.75
|
| Rate for Payer: BCBS MAPPO |
$140.62
|
| Rate for Payer: BCBS Trust/PPO |
$308.29
|
| Rate for Payer: BCBS Trust/PPO |
$462.43
|
| Rate for Payer: BCN Commercial |
$462.43
|
| Rate for Payer: BCN Commercial |
$308.29
|
| Rate for Payer: BCN Medicare Advantage |
$140.62
|
| Rate for Payer: BCN Medicare Advantage |
$93.75
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Cofinity Commercial |
$483.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.75
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Healthscope Commercial |
$506.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.88
|
| Rate for Payer: Mclaren Medicaid |
$99.17
|
| Rate for Payer: Mclaren Medicaid |
$66.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.44
|
| Rate for Payer: Meridian Medicaid |
$69.41
|
| Rate for Payer: Meridian Medicaid |
$104.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$154.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.75
|
| Rate for Payer: Nomi Health Commercial |
$461.25
|
| Rate for Payer: Nomi Health Commercial |
$307.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.88
|
| Rate for Payer: PACE Senior Care Partners |
$133.59
|
| Rate for Payer: PACE Senior Care Partners |
$89.06
|
| Rate for Payer: PACE SWMI |
$140.62
|
| Rate for Payer: PACE SWMI |
$93.75
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: PHP Commercial |
$478.12
|
| Rate for Payer: PHP Medicare Advantage |
$93.75
|
| Rate for Payer: PHP Medicare Advantage |
$140.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$489.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$326.25
|
| Rate for Payer: Priority Health Medicare |
$142.03
|
| Rate for Payer: Priority Health Medicare |
$94.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$391.50
|
| Rate for Payer: Railroad Medicare Medicare |
$93.75
|
| Rate for Payer: Railroad Medicare Medicare |
$140.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$495.00
|
| Rate for Payer: UHC Core |
$469.69
|
| Rate for Payer: UHC Core |
$313.12
|
| Rate for Payer: UHC Exchange |
$140.62
|
| Rate for Payer: UHC Exchange |
$93.75
|
| Rate for Payer: UHC Medicaid |
$99.17
|
| Rate for Payer: UHC Medicaid |
$66.11
|
| Rate for Payer: UHC Medicare Advantage |
$93.75
|
| Rate for Payer: UHC Medicare Advantage |
$140.62
|
| Rate for Payer: UHCCP Medicaid |
$66.11
|
| Rate for Payer: UHCCP Medicaid |
$99.17
|
| Rate for Payer: VA VA |
$93.75
|
| Rate for Payer: VA VA |
$140.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.25
|
|
|
HC LOWER EXT FASCIAL PLANE BLOCK UNILAT INJ
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 64473
|
| Hospital Charge Code |
37000029
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: BCBS Trust/PPO |
$247.77
|
| Rate for Payer: BCBS Trust/PPO |
$371.65
|
| Rate for Payer: BCN Commercial |
$247.77
|
| Rate for Payer: BCN Commercial |
$371.65
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$391.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$261.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC LOWER EXT FASCIAL PLANE BLOCK UNILAT INJ
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 64473
|
| Hospital Charge Code |
37000029
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$52.89 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$117.00
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.62
|
| Rate for Payer: BCBS Complete |
$55.53
|
| Rate for Payer: BCBS Complete |
$83.30
|
| Rate for Payer: BCBS MAPPO |
$75.00
|
| Rate for Payer: BCBS MAPPO |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$246.63
|
| Rate for Payer: BCBS Trust/PPO |
$369.94
|
| Rate for Payer: BCN Commercial |
$369.94
|
| Rate for Payer: BCN Commercial |
$246.63
|
| Rate for Payer: BCN Medicare Advantage |
$112.50
|
| Rate for Payer: BCN Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Mclaren Medicaid |
$79.33
|
| Rate for Payer: Mclaren Medicaid |
$52.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.75
|
| Rate for Payer: Meridian Medicaid |
$55.53
|
| Rate for Payer: Meridian Medicaid |
$83.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.50
|
| Rate for Payer: PACE Senior Care Partners |
$106.88
|
| Rate for Payer: PACE Senior Care Partners |
$71.25
|
| Rate for Payer: PACE SWMI |
$112.50
|
| Rate for Payer: PACE SWMI |
$75.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: PHP Medicare Advantage |
$75.00
|
| Rate for Payer: PHP Medicare Advantage |
$112.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$391.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$261.00
|
| Rate for Payer: Priority Health Medicare |
$113.62
|
| Rate for Payer: Priority Health Medicare |
$75.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.20
|
| Rate for Payer: Railroad Medicare Medicare |
$75.00
|
| Rate for Payer: Railroad Medicare Medicare |
$112.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: UHC Exchange |
$112.50
|
| Rate for Payer: UHC Exchange |
$75.00
|
| Rate for Payer: UHC Medicaid |
$79.33
|
| Rate for Payer: UHC Medicaid |
$52.89
|
| Rate for Payer: UHC Medicare Advantage |
$75.00
|
| Rate for Payer: UHC Medicare Advantage |
$112.50
|
| Rate for Payer: UHCCP Medicaid |
$52.89
|
| Rate for Payer: UHCCP Medicaid |
$79.33
|
| Rate for Payer: VA VA |
$75.00
|
| Rate for Payer: VA VA |
$112.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC LOW-LEVEL LASER THERAPY
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 0552T
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: BCBS Trust/PPO |
$77.34
|
| Rate for Payer: BCN Commercial |
$77.34
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.40
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC LOW-LEVEL LASER THERAPY
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 0552T
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.51 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$24.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.26
|
| Rate for Payer: BCBS Complete |
$17.33
|
| Rate for Payer: BCBS MAPPO |
$23.41
|
| Rate for Payer: BCBS Trust/PPO |
$76.98
|
| Rate for Payer: BCN Commercial |
$76.98
|
| Rate for Payer: BCN Medicare Advantage |
$23.41
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.41
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$16.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.58
|
| Rate for Payer: Meridian Medicaid |
$17.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PACE Senior Care Partners |
$22.24
|
| Rate for Payer: PACE SWMI |
$23.41
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: PHP Medicare Advantage |
$23.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.47
|
| Rate for Payer: Priority Health Medicare |
$23.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.17
|
| Rate for Payer: Railroad Medicare Medicare |
$23.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.40
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: UHC Exchange |
$23.41
|
| Rate for Payer: UHC Medicaid |
$16.51
|
| Rate for Payer: UHC Medicare Advantage |
$23.41
|
| Rate for Payer: UHCCP Medicaid |
$16.51
|
| Rate for Payer: VA VA |
$23.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC LP (A) CHOLESTEROL LMPP
|
Facility
|
IP
|
$24.41
|
|
|
Service Code
|
CPT 83700
|
| Hospital Charge Code |
30100636
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$21.97 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: BCBS Trust/PPO |
$20.16
|
| Rate for Payer: BCN Commercial |
$20.16
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Cofinity Commercial |
$20.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.53
|
| Rate for Payer: Healthscope Commercial |
$21.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.75
|
| Rate for Payer: Nomi Health Commercial |
$20.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.31
|
| Rate for Payer: PHP Commercial |
$20.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.48
|
| Rate for Payer: UHC Core |
$20.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.31
|
|
|
HC LP (A) CHOLESTEROL LMPP
|
Facility
|
OP
|
$24.41
|
|
|
Service Code
|
CPT 83700
|
| Hospital Charge Code |
30100636
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$21.97 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Medicare |
$6.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.63
|
| Rate for Payer: BCBS Complete |
$4.52
|
| Rate for Payer: BCBS MAPPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$20.07
|
| Rate for Payer: BCN Commercial |
$20.07
|
| Rate for Payer: BCN Medicare Advantage |
$6.10
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Cofinity Commercial |
$20.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.10
|
| Rate for Payer: Healthscope Commercial |
$21.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.31
|
| Rate for Payer: Mclaren Medicaid |
$4.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.41
|
| Rate for Payer: Meridian Medicaid |
$4.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.75
|
| Rate for Payer: Nomi Health Commercial |
$20.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.31
|
| Rate for Payer: PACE Senior Care Partners |
$5.80
|
| Rate for Payer: PACE SWMI |
$6.10
|
| Rate for Payer: PHP Commercial |
$20.75
|
| Rate for Payer: PHP Medicare Advantage |
$6.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.24
|
| Rate for Payer: Priority Health Medicare |
$6.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.99
|
| Rate for Payer: Railroad Medicare Medicare |
$6.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.48
|
| Rate for Payer: UHC Core |
$20.38
|
| Rate for Payer: UHC Exchange |
$6.10
|
| Rate for Payer: UHC Medicaid |
$4.30
|
| Rate for Payer: UHC Medicare Advantage |
$6.10
|
| Rate for Payer: UHCCP Medicaid |
$4.30
|
| Rate for Payer: VA VA |
$6.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.31
|
|
|
HC LTC ROOM AND BOARD
|
Facility
|
IP
|
$377.40
|
|
| Hospital Charge Code |
11000003
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$262.67 |
| Max. Negotiated Rate |
$2,177.50 |
| Rate for Payer: Aetna Commercial |
$320.79
|
| Rate for Payer: Aetna Medicare |
$1,811.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,177.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,177.50
|
| Rate for Payer: BCBS MAPPO |
$1,742.00
|
| Rate for Payer: BCBS Trust/PPO |
$311.69
|
| Rate for Payer: BCN Commercial |
$311.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,742.00
|
| Rate for Payer: Cash Price |
$301.92
|
| Rate for Payer: Cash Price |
$301.92
|
| Rate for Payer: Cofinity Commercial |
$324.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,742.00
|
| Rate for Payer: Healthscope Commercial |
$339.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,829.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,003.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,916.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.79
|
| Rate for Payer: Nomi Health Commercial |
$309.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.05
|
| Rate for Payer: PACE Senior Care Partners |
$1,654.90
|
| Rate for Payer: PACE SWMI |
$1,742.00
|
| Rate for Payer: PHP Commercial |
$320.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,742.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$328.34
|
| Rate for Payer: Priority Health Medicare |
$1,759.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1,915.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.11
|
| Rate for Payer: UHC Core |
$315.13
|
| Rate for Payer: UHC Exchange |
$1,915.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,915.00
|
| Rate for Payer: VA VA |
$1,742.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.05
|
|
|
HC LT/RT/C'S/CABG'S W INTERVENTION
|
Facility
|
IP
|
$12,605.08
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
48100051
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,773.14 |
| Max. Negotiated Rate |
$11,344.57 |
| Rate for Payer: Aetna Commercial |
$10,714.32
|
| Rate for Payer: BCBS Trust/PPO |
$10,410.54
|
| Rate for Payer: BCN Commercial |
$10,410.54
|
| Rate for Payer: Cash Price |
$10,084.06
|
| Rate for Payer: Cofinity Commercial |
$10,840.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,084.06
|
| Rate for Payer: Healthscope Commercial |
$11,344.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,453.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,714.32
|
| Rate for Payer: Nomi Health Commercial |
$10,336.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,453.81
|
| Rate for Payer: PHP Commercial |
$10,714.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10,966.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,773.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,092.47
|
| Rate for Payer: UHC Core |
$10,525.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,453.81
|
|
|
HC LT/RT/C'S/CABG'S W INTERVENTION
|
Facility
|
OP
|
$12,605.08
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
48100051
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,222.28 |
| Max. Negotiated Rate |
$11,344.57 |
| Rate for Payer: Aetna Commercial |
$10,714.32
|
| Rate for Payer: Aetna Medicare |
$3,277.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,939.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,939.09
|
| Rate for Payer: BCBS Complete |
$2,333.20
|
| Rate for Payer: BCBS MAPPO |
$3,151.27
|
| Rate for Payer: BCBS Trust/PPO |
$10,362.64
|
| Rate for Payer: BCN Commercial |
$10,362.64
|
| Rate for Payer: BCN Medicare Advantage |
$3,151.27
|
| Rate for Payer: Cash Price |
$10,084.06
|
| Rate for Payer: Cofinity Commercial |
$10,840.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,084.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,151.27
|
| Rate for Payer: Healthscope Commercial |
$11,344.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,453.81
|
| Rate for Payer: Mclaren Medicaid |
$2,222.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,308.83
|
| Rate for Payer: Meridian Medicaid |
$2,333.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,623.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,466.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,714.32
|
| Rate for Payer: Nomi Health Commercial |
$10,336.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,453.81
|
| Rate for Payer: PACE Senior Care Partners |
$2,993.71
|
| Rate for Payer: PACE SWMI |
$3,151.27
|
| Rate for Payer: PHP Commercial |
$10,714.32
|
| Rate for Payer: PHP Medicare Advantage |
$3,151.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,222.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10,966.42
|
| Rate for Payer: Priority Health Medicare |
$3,182.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,773.14
|
| Rate for Payer: Railroad Medicare Medicare |
$3,151.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,092.47
|
| Rate for Payer: UHC Core |
$10,525.24
|
| Rate for Payer: UHC Exchange |
$3,151.27
|
| Rate for Payer: UHC Medicaid |
$2,222.28
|
| Rate for Payer: UHC Medicare Advantage |
$3,151.27
|
| Rate for Payer: UHCCP Medicaid |
$2,222.28
|
| Rate for Payer: VA VA |
$3,151.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,453.81
|
|
|
HC LUMASON PER ML
|
Facility
|
IP
|
$81.09
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
63600066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.44 |
| Max. Negotiated Rate |
$72.98 |
| Rate for Payer: Aetna Commercial |
$68.93
|
| Rate for Payer: BCBS Trust/PPO |
$66.97
|
| Rate for Payer: BCN Commercial |
$66.97
|
| Rate for Payer: Cash Price |
$64.87
|
| Rate for Payer: Cofinity Commercial |
$69.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.87
|
| Rate for Payer: Healthscope Commercial |
$72.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.93
|
| Rate for Payer: Nomi Health Commercial |
$66.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.82
|
| Rate for Payer: PHP Commercial |
$68.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$70.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.36
|
| Rate for Payer: UHC Core |
$67.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.82
|
|
|
HC LUMASON PER ML
|
Facility
|
OP
|
$81.09
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
63600066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$72.98 |
| Rate for Payer: Aetna Commercial |
$68.93
|
| Rate for Payer: Aetna Medicare |
$21.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.34
|
| Rate for Payer: BCBS Complete |
$15.01
|
| Rate for Payer: BCBS MAPPO |
$20.27
|
| Rate for Payer: BCBS Trust/PPO |
$66.66
|
| Rate for Payer: BCN Commercial |
$66.66
|
| Rate for Payer: BCN Medicare Advantage |
$20.27
|
| Rate for Payer: Cash Price |
$64.87
|
| Rate for Payer: Cofinity Commercial |
$69.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.27
|
| Rate for Payer: Healthscope Commercial |
$72.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.82
|
| Rate for Payer: Mclaren Medicaid |
$14.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.29
|
| Rate for Payer: Meridian Medicaid |
$15.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.93
|
| Rate for Payer: Nomi Health Commercial |
$66.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.82
|
| Rate for Payer: PACE Senior Care Partners |
$19.26
|
| Rate for Payer: PACE SWMI |
$20.27
|
| Rate for Payer: PHP Commercial |
$68.93
|
| Rate for Payer: PHP Medicare Advantage |
$20.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$70.55
|
| Rate for Payer: Priority Health Medicare |
$20.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.44
|
| Rate for Payer: Railroad Medicare Medicare |
$20.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.36
|
| Rate for Payer: UHC Core |
$67.71
|
| Rate for Payer: UHC Exchange |
$20.27
|
| Rate for Payer: UHC Medicaid |
$14.30
|
| Rate for Payer: UHC Medicare Advantage |
$20.27
|
| Rate for Payer: UHCCP Medicaid |
$14.30
|
| Rate for Payer: VA VA |
$20.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.82
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
OP
|
$763.51
|
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$687.16 |
| Rate for Payer: Aetna Commercial |
$648.98
|
| Rate for Payer: Aetna Medicare |
$198.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.60
|
| Rate for Payer: BCBS Complete |
$141.33
|
| Rate for Payer: BCBS MAPPO |
$190.88
|
| Rate for Payer: BCBS Trust/PPO |
$627.68
|
| Rate for Payer: BCN Commercial |
$627.68
|
| Rate for Payer: BCN Medicare Advantage |
$190.88
|
| Rate for Payer: Cash Price |
$610.81
|
| Rate for Payer: Cash Price |
$610.81
|
| Rate for Payer: Cofinity Commercial |
$656.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.88
|
| Rate for Payer: Healthscope Commercial |
$687.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$572.63
|
| Rate for Payer: Mclaren Medicaid |
$134.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.42
|
| Rate for Payer: Meridian Medicaid |
$141.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$209.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.98
|
| Rate for Payer: Nomi Health Commercial |
$626.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.63
|
| Rate for Payer: PACE Senior Care Partners |
$181.33
|
| Rate for Payer: PACE SWMI |
$190.88
|
| Rate for Payer: PHP Commercial |
$648.98
|
| Rate for Payer: PHP Medicare Advantage |
$190.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$664.25
|
| Rate for Payer: Priority Health Medicare |
$192.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$531.40
|
| Rate for Payer: Railroad Medicare Medicare |
$190.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$671.89
|
| Rate for Payer: UHC Core |
$637.53
|
| Rate for Payer: UHC Exchange |
$190.88
|
| Rate for Payer: UHC Medicaid |
$134.61
|
| Rate for Payer: UHC Medicare Advantage |
$190.88
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: VA VA |
$190.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$572.63
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
IP
|
$763.51
|
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$531.40 |
| Max. Negotiated Rate |
$687.16 |
| Rate for Payer: Aetna Commercial |
$648.98
|
| Rate for Payer: BCBS Trust/PPO |
$630.58
|
| Rate for Payer: BCN Commercial |
$630.58
|
| Rate for Payer: Cash Price |
$610.81
|
| Rate for Payer: Cofinity Commercial |
$656.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.81
|
| Rate for Payer: Healthscope Commercial |
$687.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$572.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.98
|
| Rate for Payer: Nomi Health Commercial |
$626.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.63
|
| Rate for Payer: PHP Commercial |
$648.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$664.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$531.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$671.89
|
| Rate for Payer: UHC Core |
$637.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$572.63
|
|
|
HC LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
OP
|
$934.71
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
36100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.79 |
| Max. Negotiated Rate |
$841.24 |
| Rate for Payer: Aetna Commercial |
$794.50
|
| Rate for Payer: Aetna Medicare |
$243.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.10
|
| Rate for Payer: BCBS Complete |
$173.01
|
| Rate for Payer: BCBS MAPPO |
$233.68
|
| Rate for Payer: BCBS Trust/PPO |
$768.43
|
| Rate for Payer: BCN Commercial |
$768.43
|
| Rate for Payer: BCN Medicare Advantage |
$233.68
|
| Rate for Payer: Cash Price |
$747.77
|
| Rate for Payer: Cofinity Commercial |
$803.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$747.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.68
|
| Rate for Payer: Healthscope Commercial |
$841.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$701.03
|
| Rate for Payer: Mclaren Medicaid |
$164.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.36
|
| Rate for Payer: Meridian Medicaid |
$173.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$257.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$794.50
|
| Rate for Payer: Nomi Health Commercial |
$766.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$701.03
|
| Rate for Payer: PACE Senior Care Partners |
$221.99
|
| Rate for Payer: PACE SWMI |
$233.68
|
| Rate for Payer: PHP Commercial |
$794.50
|
| Rate for Payer: PHP Medicare Advantage |
$233.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$813.20
|
| Rate for Payer: Priority Health Medicare |
$236.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$650.56
|
| Rate for Payer: Railroad Medicare Medicare |
$233.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$822.54
|
| Rate for Payer: UHC Core |
$780.48
|
| Rate for Payer: UHC Exchange |
$233.68
|
| Rate for Payer: UHC Medicaid |
$164.79
|
| Rate for Payer: UHC Medicare Advantage |
$233.68
|
| Rate for Payer: UHCCP Medicaid |
$164.79
|
| Rate for Payer: VA VA |
$233.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$701.03
|
|
